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Speech and Voice Problems in the Elderly

Problems with speaking are not an age-related change in the elderly but rather linked to some underlying disorder. Although there are changes in the voice with advancing age, this does not reach a point where a person cannot speak. Several conditions that are more likely to occur in elderly people can lead to problems with speech or the voice. These different types of problems needs to be carefully investigated in order to identify the area that is affected thereby leading to a disruption with speech or the voice.

Normal Voice and Speech

The ability to speak requires three different processes :

Sound is produced in the voice box – phonation.

Formation of words in the mouth – articulation.

The brain controls the above two functions and processes specific thoughts into sequences that allows for phonation and articulation.

Air that is exhaled is altered by the action of the vocal cords in the voice box to produce sound (phonation). The movement of the mouth, tongue and throat facilitates the formation of words (articulation). All of these movements, both of the vocal cords and muscles responsible for articulation are controlled by the brain via impulses relayed through nerves. Phonation and articulation, jointly known as vocalization, is the last process after the brain decides which words will be spoken (conceptualization) and then recalls the movements to form these words (formulation).

Types of Speech Problems

There are various different medical terms to describe a host of disorders that may affect the voice and speech. These conditions also have a number of different causes, most of which revolve around neurological disorders in the elderly such as a stroke and Parkinson’s disease.

Dysphonia is the difficulty producing sounds (phonation) stemming from a problem with the voice box or the muscles and nerves that control the vocal cords. The voice may be hoarses or very soft like a whisper. Sometimes there is a total loss of the voice (muteness).

Dysarthria is the difficulty with forming the words due to a problem with the muscles of the mouth and tongue or the nerves that control it. The speech is typically slurred and may still be decipharable in less severe cases.

Apraxia of speech is the difficulty or inability to carry out the muscle movements to form words due to damage to parts of the brain. Apraxia itself is a broad term used to describe any problem with voluntary movements of muscles, not only in the mouth or involving speech.

Aphasia is a language rather than a speech disorder. Here a person has difficulty forming sentences or selecting the right words due to brain lesions. There are several different subtypes of aphasia.

There are other types of speech problems which may occur in the elderly but these other conditions are either present from birth or earlier in life, or not often seen in the elderly. Identifying these types of speech and voice problems mentioned above and seeking medical attention can reveal diseases and disorders that have not as yet been diagnosed. Despite the host of changes in the body with advancing age, the speech and voice problems mentioned above are not present unless there is an underlying medical condition.

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